What Should I Do About Acid Reflux During Chemotherapy?

How cancer treatment can trigger reflux and what you can do about it

AMBULATORY CHEMOTHERAPY
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Acid reflux is a digestive condition in which stomach acid or bile flows upward from the stomach into the esophagus resulting in irritation. The irritation can be in the throat or chest, which commonly presents as heartburn. Symptoms can also include a sore throat or lump in the throat, coughing, sour or bitter taste in the mouth, indigestion, difficulty swallowing, and asthma-like symptoms. It's thought that up to 30% of people in the U.S. experience acid reflux, and it affects all age groups and ethnicities.

Contrary to popular belief, acid reflux is not always caused by an excess of stomach acid and is often a result of not having enough stomach acid and/or digestive enzymes to efficiently break down a meal. Certain foods, beverages, and over-eating all contribute to the problem. Excess pressure on the abdomen from being overweight, obese, or pregnant can exacerbate acid reflux as well.

Other Causes of Acid Reflux

  • Taking certain medications like aspirin, ibuprofen, muscle relaxers, blood pressure medications, anti-depressants, etc.
  • Taking OTC medications and proton-pump inhibitors (PPI) to control acid reflux, which can have a boomerang effect, especially if the condition is due to low stomach acid.
  • Having a stomach infection with the helicobacter pylori bacteria, which neutralizes stomach acid. H. pylori is thought to infect 50% of people.
  • A structural abnormality called a hiatal hernia.

Hiatal hernias are thought to affect up to 60% of people over age 50. That can be a common cause of acid reflux in this age group, combined with less stomach acid which decreases as we age.

Normally, the diaphragm separates the chest cavity from the abdomen, and helps keep acid in the stomach, but with a hiatal hernia, the top part of the stomach pushes through the normal opening of the diaphragm into the chest cavity. Without a strong barrier between the stomach and the esophagus, acid can then move up into the esophagus and cause symptoms of acid reflux.

Anyone can get a hiatal hernia, since it is caused by excess pressure in the abdomen, but they happen most commonly in people who smoke, are overweight, or individuals older than 50.

Why Chemotherapy Increases Acid Reflux

Acid reflux can be common both while undergoing chemotherapy and after treatment has ended. That's because chemotherapy drugs work by targeting rapidly dividing cells, including the cells in the lining of the stomach and digestive tract, which protect the digestive organs from corrosive stomach acid. Chemotherapy drugs simply cannot tell the difference between these normal, rapidly dividing cells and cancer cells, so the drug attacks these cells as well.

When Experiencing Acid Reflux It's Best to Avoid

  • Eating large meals
  • Lying down or bending over at the waist right after a meal
  • Snacking close to bedtime
  • Eating certain foods such as citrus, tomato, chocolate, mint, garlic, onions, or spicy or fatty foods
  • Eating foods that are hard to digest such as animal protein and dairy
  • Drinking certain beverages, such as alcohol, carbonated drinks, coffee, or tea
  • Smoking
  • Wearing tight clothing or belts

Try to keep a symptom record to determine if a certain food or activity triggers your acid reflux. Some people find fried foods or carbonated beverages cause or worsen it. Keeping track of when it occurs can help you to eliminate foods or other things that exacerbate your symptoms.

Treatment Options

Digestive enzymes as well as increasing stomach acid with betaine hydrochloric acid (HCL) tablets found at health food stores may be all that's needed to relieve acid reflux for some healthy individuals; however special considerations should be taken for those undergoing chemotherapy treatment due to the increased digestive sensitivity caused by chemotherapy.

Over-the-counter (OTC) acid reflux medication as well as proton-pump inhibitors (PPIs) prescribed by healthcare providers are a common course of treatment to relieve acid reflux, but studies have shown that these medications may reduce the effectiveness of certain chemotherapy drugs. Additionally, PPIs as well as OTC acid reflux medications should only be used for short periods of time as side effects of prolonged use may include decreased stomach acid (hypochlorhydria), reduced nutrient absorption (malabsorption), increased risk of infection, osteoporosis, and cancer, as well as an increased risk of dementia, kidney disease, and death in long-term PPI users.

Because certain foods can aggravate your heartburn symptoms, when planning your acid reflux diet, it's best to limit or completely avoid those foods and drinks. Conversely, there are some foods that have little or no potential for causing heartburn. Some people may have success by changing their diet, eating habits, and introducing other interventional measures like elevating the head of their beds so they're lying on an incline.

If lifestyle changes to prevent your acid reflux are not enough, seek medical advice from your primary care provider and a licensed nutritionist knowledgeable about digestive disorders before beginning any medication.

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